Provider Demographics
NPI:1962068437
Name:CARDINAL CHIROPRACTIC AND SPORTS RECOVERY PLLC
Entity type:Organization
Organization Name:CARDINAL CHIROPRACTIC AND SPORTS RECOVERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HOEWYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-550-0798
Mailing Address - Street 1:1710 WESTBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8721
Mailing Address - Country:US
Mailing Address - Phone:336-270-3050
Mailing Address - Fax:
Practice Address - Street 1:1710 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8721
Practice Address - Country:US
Practice Address - Phone:336-270-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty